Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis - 04/03/15

Doi : 10.1016/j.ajog.2015.01.009

Miriam F. van Oostwaard, MD ^a,^⁎ , Josje Langenveld, MD, PhD ^b, Ewoud Schuit, MSc, PhD ^c,^d,^g, Dimitri N.M. Papatsonis, MD, PhD ^e, Mark A. Brown, MD, PhD ^h, Romano N. Byaruhanga, MD, PhD ^j, Sohinee Bhattacharya, MD, PhD ^k, Doris M. Campbell, MD, PhD ^l, Lucy C. Chappell, MD, PhD ^m, Francesca Chiaffarino, ScD ^p, Isabella Crippa, MD, PhD ^r, Fabio Facchinetti, MD, PhD ^s, Sergio Ferrazzani, MD, PhD ^t, Enrico Ferrazzi, MD, PhD ^q, Ernesto A. Figueiró-Filho, MD, PhD ^u, Ingrid P.M. Gaugler-Senden, MD, PhD ^f, Camilla Haavaldsen, MD, PhD ^w, Jacob A. Lykke, MD, PhD ^x, Alfred K. Mbah, PhD ^y, Vanessa M. Oliveira, MD, PhD ^v, Lucilla Poston, MD, PhD ^m, Christopher W.G. Redman, MD, PhD ^o, Raed Salim, MD, PhD ^z, Baskaran Thilaganathan, MD, PhD ⁿ, Patrizia Vergani, MD, PhD ^r, Jun Zhang, MD, PhD ^aa, Eric A.P. Steegers, MD, PhD ^a, Ben Willem J. Mol, MD, PhD ⁱ, Wessel Ganzevoort, MD, PhD ^d
^a Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
^b Department of Obstetrics and Gynecology, Atrium Medical Center, Heerlen, the Netherlands
^c Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum, Utrecht, the Netherlands
^d Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands
^e Department of Obstetrics and Gynecology, Amphia Ziekenhuis, Breda, the Netherlands
^f Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch, the Netherlands
^g Stanford Prevention Research Center, Stanford University, Stanford, CA, Australia
^h Department of Renal Medicine, St. George Hospital, Sydney, NSW, Australia
ⁱ School of Pediatrics and Reproductive Health, Robinson Institute, University of Adelaide, SA, Australia
^j Department of Obstetrics and Gynecology, St. Raphael of St. Francis Hospital, Nsambya Kampala, Uganda
^k Dugald Baird Center for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland
^l Department of Obstetrics and Gynecology, Aberdeen Maternity Hospital, Aberdeen, Scotland
^m Women’s Health Academic Centre, King’s College London, London, England, UK
ⁿ Lanesborough Wing, St George’s, University of London, London, England, UK
^o Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, University of Oxford, Oxford, England, UK
^p Department of Obstetrics, Gynecology, and Neonatology, IRCSS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
^q Department of Woman, Mother, and Neonate, Buzzi Children’s Hospital, Istituti Clinici di Perfezionamento, Biomedical and Clinical School of Medicine University of Milan, Milan, Italy
^r Department of Obstetrics and Gynecology, Ospedale San Gerardo, Università degli Studi di Milano-Bicocca, Monza, Italy
^s Department of Obstetrics and Gynecology, Universit’ degli Studi di Modena e Reggio Emilia, Modena, Italy
^t Department of Obstetrics and Gynecology, Università Cattolica del S. Cuore, Rome, Italy
^u Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
^v Center for Biological and Health Sciences, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
^w Department of Gynecology and Obstetrics and Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Lørenskog, Norway
^x Department of Obstetrics and Gynecology, Hvidovre Hospital, and Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
^y Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL
^z Department of Obstetrics and Gynecology, Ha’Emek Medical Center, Afula, Israel
^aa Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

^∗Corresponding author: Miriam F. van Oostwaard, MD.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 04 March 2015
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Objective

We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes.

Study Design

We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI.

Results

Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n = 152,213; 95% CI, 17.9–18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4–20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6–14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4–8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16–0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2–3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3–6.1).

Conclusion

Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.

Le texte complet de cet article est disponible en PDF.

Key words : gestational hypertension, HELLP syndrome, IPD, preeclampsia, pregnancy, recurrence

Plan

Materials and Methods

The clinical syndrome in the index and subsequent pregnancy

Chronic hypertension after pregnancy

Comment

Main findings

Strengths and weaknesses

Counseling

	The authors report no conflict of interest.
	Cite this article as: van Oostwaard MF, Langenveld J, Schuit E, et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015;212:••••.